Family Dynamics

Category: Education

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Families are complex units that are bonded by strong emotional connections. Major social institution found in all human societies


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‘Family Dynamics in Sickle Cell Disorder’ By Oluwatoyin Olatundun ILESANMI (PhD) Clinical Psychologist, PN & M, Trained Genetic Counsellor, USIP Certificate in Conflict Analysis:

‘Family Dynamics in Sickle Cell Disorder ’ By Oluwatoyin Olatundun ILESANMI (PhD) Clinical Psychologist, PN & M, Trained Genetic Counsellor, USIP Certificate in Conflict Analysis Address: Centre for Gender & Social Policy Studies, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria. E-mail: Phone: +2348052236377

What is a Family?:

What is a Family? Families are complex units that are bonded by strong emotional connections. Major social institution found in all human societies Structure: The nuclear family, which has a mother, father and children Extended Families: Step-parents or multiple generations, such as parents and grandparents, living in the same household. These different family structures can create a variety of family dynamics . Usual image: working father + housewife mother + dependent children 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 2

Functions of the Family:

Functions of the Family Functions: Companionship (“marry for love”) Sex and reproduction Socialisation of children Social support (especially during crises) Economic cooperation

Healthy Family :

Healthy Family Effects on Illness Behaviour : Stoic? self-medicate? seek alternative medicine? Effects on medical adherence e.g. religion & health (faith healing, Jehovah’s Witness) 2) Effects on patients with long term illness: Quality of care provided by family members (female relatives as care providers for kids, husbands, in-laws and elderly parents) 3) Family and social networks promote health: Socially isolated have poorer mental health; recover slower from sickness 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 4

Family Dynamics:

Family Dynamics 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 5

Unhealthy Family or Dysfunctional Family:

Unhealthy Family or Dysfunctional Family 1 ) Troubled family has a negative effect on the physical or psychological well-being of its individual family members” 2) Poor parenting : Child abuse – neglect, physical abuse, verbal abuse, sexual abuse, Overindulgence, Domestic violence, Alcoholism and substance-abuse in the family, Gambling problems

Family Dynamics?:

Family Dynamics? The ways in which members of a family interact with each other and in relation to the group as a whole are often referred to as family dynamics. (Multiple Roles + Changing dynamic +Family Relationships) Family dynamics between family members are influenced by: Family Communication style: Families that are very busy may not always take time to communicate openly. Younger members of a family learn communication skills from the older members, and patterns of conflict or anger tend to be acquired by the children. Effective listening skills and empathy are critical to developing functional family communication . Talking need not be constant, but avoiding talking altogether can lead to confusion and disconnection. Behavioral patterns : Emotional interdependence : Cultural Traditions/ practices : Family structure: This provides benefits and challenges 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 7

SCD & Family Dynamics I:

SCD & Family Dynamics I Impacts of SCD alter relationships and dynamics within a family in the following adjustment levels: Family Stability: Issues such as financial concerns in SCD management may threaten the financial stability of the family. Quality of Parenting : is one of the best predictors of children's emotional and social well-being. Parents have a primary role in the formation of a child's values and behaviors. Factors outside the family and the child's own personality may also affect the child's development. Less emotionally supportive parents usually have fewer rules, dispense harsher discipline, are more inconsistent in dispensing discipline, provide less supervision, and engage in more conflict with their children Emotional Disconnection : It may severely challenge the emotional and behavioral functioning of families (i.e. Increased strain ). 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 8

SCD & Family Dynamics I:

SCD & Family Dynamics I The presence of illness can change relationships in the family. Stages Pre-diagnostic Phase: Parental Premonitions, Professional and Family reactions, Family Relationships: Strengths and fragmentation Diagnosis: The illness role produced by the diagnosis, adds uncertainty to every relationship and every other role Confirmation : Shock and Relief, Family Reactions, Changing Roles, Information Giving, Siblings and Teenagers, Implications of Non-disclosure, “ Friendly advice” and the internet, The Family, Reactions of Friends, Support Networks The Long Haul: Reality , Practical Resources, Siblings, Friends and Family, Treatment Considerations, Future Pregnancies, Young Adults with SCD The End Phase: The new status, Palliative Care, Support Networks 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 9

SCD & The Family II:

SCD & The Family II Family’s daily life functioning: : may be disrupted by Frequent, unexpected or even frightening c rises -- illness, mental health issues, or trauma. This can put family members under unusual stress as normal routines are constantly being interrupted. The entire family system may become absorbed by the problem. In these cases families should take part in counseling together to explore how their individual experiences and problems may be affecting other members of their household. Family therapy often focuses on improved communication and gradual change of unhealthy or maladaptive dynamics, Psychosocial problems may be present: adequate support required Economic suffering: With only one parent money is tighter, thus sometimes leading to deprivation of basic needs 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 10

SCD & The Family III:

SCD & The Family III Interpersonal relationships within the family : ill child's presence in the home may alter the: Parents and other offspring interaction Parent and the affected child interaction Siblings and the affected child interaction Exposure to “Stress”- Children living with single parents are exposed to more stressful experiences and circumstances than are children living with continuously married parents. Economic hardship, unskilled parenting, and loss of contact with a parent can be stressful for children. Social Activities: Child's presence reduces the ability of the primary parent to participate in social activities outside of the family . 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 11

Psychosocial Issues:

Psychosocial Issues Impact of pain & symptoms Society’s attitudes to SCD & affected Cultural factors important beliefs and practices ‘ Crisis’ of a chronic illness Cognitive changes major challenges 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 12

Parents Emotional Reaction:

Parents Emotional Reaction May include: The future outlook of the child: Resentment: Disappointment: Guilt: Anxiety: Free floating anxiety, worries and anxieties that have no where particular to pin themselves and may look for a place to project themselves or phobias, sleep disturbances, hyper-vigilance etc. Anger: Embarrassment: Overly restrictive and overprotective: Pushing the child to achieve beyond his/her capabilities Rejecting the child 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 13

Psychosocial Impact on the affected child:

Psychosocial Impact on the affected child Depression : Unexpressed and unfelt emotion can lead to flat internal world – or an agitated/anxious defense against feeling internal pain. Or anger, rage and sadness that remain unfelt or unexpected in a way that leads to no resolution and becomes turned inward within the self. Lowered self-esteem: Social distability : Chronic anxiety: Poor school achievement: increasing adaptive behavior deficits: 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 14

Cognitive Challenge:

Cognitive Challenge Family must learn about illness cause prognosis complications Family must revise expectations for child daily life present & future 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 15

Emotional Challenge:

Emotional Challenge Coming to terms with the illness uncertainties disease process Thoughts & feelings about outcome fears & anxieties hoping & praying 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 16

Behavioural Challenge:

Behavioural Challenge Changes in family life treatment hospital visits Preservation of family function day-to-day roles other members – eg. siblings income - poverty 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 17

Individual Challenges:

Individual Challenges Identity & Role active independent to passive dependent Location hospitalisation Social Support isolation from family, friends Future career or family plans 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 18

Aggravating Factors:

Aggravating Factors Unpredictability if pain not expected, coping strategies not considered Clarity of Illness Information cause & outcome of sickle cell disease seriousness & prognosis Quick Decisions actions to be taken eg. treatment Limited Prior Experience unable to develop coping strategies 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 19

Family Dynamics & Coping Capacities:

Family Dynamics & Coping Capacities Parents ’ Coping : Parents with more knowledge about the illness and more social support available are able to cope favorably with the anxieties and uncertainties created by the illness . Therefore, it is essential for family members to learn about the course, etiology, prognosis, optimal treatment and implications of the illness on their child rearing patterns Patient’s Coping : The family also impacts on how the patient responds to the illness. Specifically, the more psychosocial stressors within the family, the less effectively the patient copes with the SCD. The more social support available to the patient from the family and other significant others, the more likely the patient is to comply with the treatment regimen. Behaviourally : The family must incorporate the treatment regimen into the family’s routine while maintaining other family functions 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 20

Individual Factors in Coping:

Individual Factors in Coping Demographic & Personal Factors age, gender, religion Social & Environmental Factors social & family support community & hospitals Illness-Related Factors pain, severity 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 21

Patients & Families:

Patients & Families Non-acceptance family genetics eg. maternal inheritance ‘bad blood’ Longevity Lifestyle diet, activity Perception ‘sickler’ over protectiveness 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 22


Culture People’s way of life Effect on psychosocial outcome attitudes & behaviour appropriate support 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 23

Cultural Factors - I:

Cultural Factors - I Language literacy comprehension Religion beliefs church, prayer Family Relations cohesion eg. extended family support Conflict Folk Medicine traditional medicine & healers complementary or substitute 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 24

Cultural Factors - II:

Cultural Factors - II Location rural or urban Degree of Acculturation ‘in tune’ with culture expression 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 25

Culture & Individual Factors:

Culture & Individual Factors Demographics eg. age, gender, socio-economic status Social & Environmental eg. social & family support Illness-Related eg. pain, disability (disease severity) locus of control coping quality of life 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 26

Culture’s Influence:

Culture’s Influence Beliefs & perceptions about ill health causes of illness eg. supernatural beliefs, reincarnation Acceptable treatment access, finance eg. folk, herbal medicine Response to symptoms where to seek treatment, help eg. traditional healer 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 27

What can we do?:

What can we do? What is Helpful Accurate Knowledge Quality Trusted Medical Care Open, Honest Communication Support Group Contact Flexible Family Structures Adequate Community Resources Negotiating Roles for Family Members A Philosophical or Religious Belief System Education Counselling Talking 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 28

PowerPoint Presentation:

THANK YOU 3/9/2012 Oluwatoyin Olatundun ILESANMI (PhD) 29

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